(Absent Menses; Amenorrhea)
Primary amenorrhea—when an adolescent female has not yet begun menstruation by around age 16 years
- Most females begin menstruating between the ages 9-18, but age 12 is the average.
- Secondary amenorrhea—when a woman who has previously menstruated misses three or more periods in a row
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- Dramatic weight loss (eg, from extreme diets, eating disorders, or excessive exercise) or dramatic weight gain
- Birth defects (eg, lack of female reproductive organs)
- Chromosomal or hormonal abnormalities
- Certain conditions (eg, thryoid disorder, pituitary tumor )
- Medicines (eg, certain contraceptives)
- Emotional distress
- Uterine scarring
When Should I Call My Doctor?
- Have not had your first period and are aged 16 years or older
- Miss having your period
- Pregnancy test
- Progestin challenge test to determine if a lack of estrogen is causing amenorrhea
- Blood work to check hormone levels
- Chromosome test to determine if there are any abnormalities
- Weight-related cause—A healthy caloric intake and exercise routine usually restores hormonal balance and menstruation.
- Birth defect—Surgery may be needed.
- Hormonal irregularity—Your doctor may prescribe hormonal therapy.
- Emotional distress—Relaxation techniques (eg, deep breathing), therapy, and exercise may help to decrease stress.
- Pituitary tumor—Surgery, radiation therapy , or medicine may be needed.
- Maintain an appropriate level of body fat.
- Get help for an eating disorder.
- Treat conditions that can lead to amenorrhea, such as polycystic ovary syndrome, pituitary tumor, and hypothyroidism.
The American Congress of Obstetricians and Gynecologists http://www.acog.org/
Women's Health.gov http://www.womenshealth.gov/
Health Canada http://www.hc-sc.gc.ca/
The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/
Amenorrhea. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html . Updated August 2010. Accessed August 13, 2012.
Current evaluation of amenorrhea. American Society for Reproductive Medicine website. Available at: http://www.asrm.org/uploadedFiles/ASRM%5FContent/News%5Fand%5FPublications/Practice%5FGuidelines/Educational%5FBulletins/Current%5Fevaluation(1).pdf . Accessed August 13, 2012.
Secondary amenorrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated February 3, 2012. Accessed August 13, 2012.
- Reviewer: Andrea Chisholm, MD
- Review Date: 09/2013 -
- Update Date: 09/30/2013 -